| NPI | 1366703142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U7125) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60749505) |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2024-01-16 |